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To evaluate the efficacy of actinomycin D (Act D) as prophylactic chemotherapy (P-chem) in patients with high-risk complete hydatidiform mole (Hr-CHM) on progression to gestational trophoblastic neoplasia (GTN). From 1996 to 2023, 426 Hr-CHMs were selected in a cohort of 1623 patients with gestational trophoblastic disease (GTD). From 1996 to 2023, 290 patients with Hr-CHMs received a single bolus dose of Act-D at the time of uterine evacuation (Hr-CHM P-chem group); 136 with the same risk factors did not receive P-chem (Hr-CHM control group). The variables assessed in post-molar GTN were incidence and morbidity considering hCG serum level at diagnosis, relapse frequency, hysterectomy rates. Post-molar GTN was diagnosed in 19 % of the patients with Hr-CHM P-Chem (55/290) and in 39.7 % of the patients in the Hr-CHM control group (54/136) (P < 0.001). The relative risk of developing post-molar GTN decreased by 52 % (RR = 0.48; 95 % CI: 0.35–0.66; P < 0.001), with a number needed to treat (NNT) of 5. Patients in the P-chem group had a lower hCG serum level (P = 0.007), lower risk of recurrence (P = 0.001) and lower risk of hysterectomy (P = 0.04), with no effect on time to GTN diagnosis (P = 0.09), first line chemotherapy response (P = 0.50) and time to remission (P = 0.72). A single bolus dose of Act-D (1.25 mg/m2) given as P-chem during uterine evacuation in patients with Hr-CHM may safely prevent the incidence of post-molar GTN and reduce the morbidity associated with GTN. This prophylactic approach can be adopted at any trophoblastic disease center (TDC). • P-chem with Act-D combined with uterine evacuation may safely prevent postmolar GTN incidence (52 % reduction). • P-chem with Act-D also reduced the morbidity associated with GTN (hCG levels, recurrence and hysterectomy). • This Act-D prophylactic regimen can be implemented at any trophoblastic disease center (TDC). [ABSTRACT FROM AUTHOR]

Hyperthyroidism in twin pregnancies involving a hydatidiform mole and a coexisting live fetus is a rare condition requiring careful management. We present a 34-year-old pregnant woman at 12 weeks' gestation with severe nausea, vomiting, and mild vaginal bleeding. A transvaginal ultrasound revealed a dichorionic diamniotic twin pregnancy with 1 normal fetus and 1 hydatidiform mole, leading to hyperthyroidism from elevated β human chorionic gonadotropin levels. Conservative management without antithyroid medications, combined with regular monitoring, allowed the pregnancy to continue to term, resulting in the delivery of a healthy baby at 39 weeks. Postpartum management required treatment of retained products of conception. This case highlights the complexities in the management of complications for both mother and fetus. [ABSTRACT FROM AUTHOR]

• Cases of vaginal metastasis are rare, and are reported to occur in 4.5–27% of cases of gestational trophoblastic neoplasia. • Approximately 45% of cases are complicated by major vaginal haemorrhage. • The presence of vaginal metastases in gestational trophoblastic neoplasia does not confer a worse prognosis. • Presence of vaginal metastases should not alter maagement plans, with tailored treatment determined by patient factors. • Chemotherapeutic regimens should be based upon World Health Organisation prognostic scores. Gestational trophoblastic neoplasia (GTN) is rare in the UK, with an estimated incidence of one in 50,000 live births. Cases of vaginal metastasis are even rarer, with only eight case series reporting 187 cases over the past 40 years. Management recommendations in the literature are scarce despite the potential risk of massive, potentially life-threatening vaginal haemorrhage. This retrospective cohort study with interval analysis was performed at Sheffield Trophoblastic Disease Centre. It included all patients diagnosed with GTN with documented evidence of vaginal metastases between 1 January 1974 and 31 December 2023. Twenty-five patients with GTN and vaginal metastases were identified during the study period, accounting for < 1 % of all GTN registrations during this period. All patients had chemotherapy representative of chemotherapeutic regimens employed at the time of diagnosis. Vaginal metastases were treated to resolution by chemotherapy alone in 76 % of cases. In addition to chemotherapy, 12 % of patients were managed with vaginal packing, 4 % underwent localized excision, 4 % underwent internal iliac embolization, and 12 % received targeted radiotherapy. Forty-four percent of patients had repeated blood transfusions due to persistent haemorrhage associated with the vaginal metastasis. One patient died from disease, 80 % achieved complete remission (cured), and 16 % (recently diagnosed) are in remission. The presence of vaginal metastases in patients with GTN has little prognostic significance, and their presence should not alter management plans. Tailored treatment should be determined by patient factors, with chemotherapeutic regimens based upon World Health Organization prognostic scores. A conservative management approach should be considered, as most cases will resolve with chemotherapy alone. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectivesMethodResultsConclusionsEvidence suggests routine pre-abortion ultrasound is unnecessary for women with regular menstrual cycles and without symptoms or risk factors for ectopic pregnancy in early gestation.We evaluated the safety and accuracy of using the decision aid for early medical abortion without ultrasound developed by the RCOG Abortion Care group in a Finnish setting.Using gestational age (GA) expected by last menstrual period (LMP), cycle irregularities, use of hormonal contraceptives, breastfeeding and self-reported symptoms indicative of possible ectopic pregnancy, women were classified into ‘no ultrasound needed’ and ‘ultrasound needed’ with a cut-off of 10 + 0 weeks or 70 days. Findings on US were then evaluated to assess classification accuracy.Between September and December 2023, 494 women attending the abortion clinic at the Helsinki University Hospital were assessed. Correct classification of the necessity of an ultrasound was made in 491/494 (99.4%) cases before the women had a scan. The remaining three cases were one woman with an unexpected GA just above 10 + 0, one asymptomatic ectopic pregnancy and one asymptomatic pregnancy of unknown location with high plasma hCG, diagnosed as a partial molar pregnancy on pathology after diagnostic vacuum aspiration.Use of the structured flowchart developed by the RCOG highly accurately identifies women needing an ultrasound examination. The few cases that would have been undetected highlight the importance of informing women and health care providers about symptoms of ectopic or abnormal pregnancy similar to practices in wanted pregnancies not routinely examined and dated before late first trimester. [ABSTRACT FROM AUTHOR]

Objective: Pre-eclampsia (PE) is a complex, advancing condition marked either by the recent emergence of hypertension and proteinuria or by the recent onset of hypertension accompanied by notable end-organ impairment, which may occur with or without proteinuria. PE usually appears in the postpartum phase or after the 20th week of gestation, though it might appear sooner in cases of molar pregnancy. Pathophysiology: This disorder is a serious multisystem condition during pregnancy that can lead to serious, life-threatening complications for both the mother and the fetus if it is not diagnosed and managed promptly. These changes result from widespread and intense vasoconstriction caused by renin, angiotensin II (Ang II), aldosterone, and catecholamines. The renin–angiotensin–aldosterone system (RAAS) and its sequence of signaling reactions demonstrate its crucial role in regulating blood pressure and electrolyte balance that diverges in PE from that observed in healthy pregnancies. However, it is widely recognized that the above description is incomplete for pre-eclampsia and further relationships should be analyzed. The purpose of this article is to review and synthesize alterations in renal function and the RAAS during normal pregnancy and pre-eclampsia. We aim to provide clinical gynecologists with a comprehensive understanding of how pregnancy-specific adaptations can impact renal function and the RAAS, as well as the deviations observed in pre-eclampsia. Conclusion: This information is essential to enhance clinical awareness, improve the accuracy of diagnosis, and support evidence-based decision-making in the management of pregnant patients, especially those complicated by pre-eclampsia. [ABSTRACT FROM AUTHOR]

Background & Objective: This study was done to assess the levels of Programmed cell death 1 (PD-1) and its ligands (PD-L1) expression in gestational trophoblastic neoplasia (GTN) to determine the outcome of prescribing anti PD-1 drugs in trophoblastic tumors. Materials & Methods: This study was conducted in the gynecology oncology clinic of Mashhad medical science university in the north-east of Iran during 2012-2022. The patients were divided into two groups consisting of low-risk and high-risk groups based on their International Federation of Gynecology and Obstetrics (FIGO) score, and subsequently their response to the chemotherapy was evaluated. We scored PD-L1 staining in tumor cells using a 4-point scoring system and evaluated PDL-1 expression using the Allered Total Score (ATS). Results: 52 GTN patients with a mean age of 27 were undergone in our study between. Out of all the patients in our study, 47 and 5 patients were diagnosed with molar pregnancy and choriocarcinoma, respectively. The patients with molar pregnancy were also sub grouped into 22 (42.3%) patients and 25 (48.1%) patients with complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM). The results of PDL-1 staining intensity showed 3 (5.8%), 12 (23.1%), 27 (51.9%), and 10 (19.2%) were No, weak, moderate, and strong staining, respectively. Conclusion: The findings of this present study indicated that the high-level PD-L1 expression in most of our patients. Seem to suggest the potential use of immune checkpoint inhibition as a treatment option for trophoblastic tumors, which deserves further comprehensive study through clinical trials. [ABSTRACT FROM AUTHOR]

Background: Gestational trophoblastic diseases (GTDs) are a group of benign and malignant tumors that arise from placental tissue. Ectopic pregnancies most commonly occur within the fallopian tubes. The estimated incidence of ectopic gestational trophoblastic diseases (GTDs) is approximated at 1.5 per 1 000 000 pregnancies, which makes it a very rare condition. The diagnosis is challenging since the clinical presentation often mimics conventional ectopic pregnancy, but management approaches are significantly different. Case Report: A 41-year-old woman (G7 T4 P0 A2 L4) presented to the Emergency Department with a period of amenorrhea followed by vaginal bleeding and abdominal pain. Right-side abdominal tenderness was noted upon physical examination. Laboratory investigations showed elevated serum b-hCG level. Ultrasound examination showed a normal-size uterus. No intrauterine gestational sac was identified. An echogenic mass with central lucency was noted in the right adnexa, measuring 2.1×1.8 cm, with minimal free fluid present in the pouch of Douglas. The findings were suggestive of a ruptured right-side ectopic pregnancy. The patient underwent laparoscopic salpingectomy. Histopathological examination of the specimen revealed a complete hydatidiform mole with vascular invasion. The patient was treated conservatively and was followed up by a serial b-hCG level until she achieved 3 consecutive negative b-hCG titers. Conclusions: Invasive moles located in the fallopian tube are very rare in the literature, and further research is needed to ascertain the proper management of such cases. Histopathological examination of the salpingectomy specimen has an essential role in confirming the diagnosis of ectopic GTDs and guiding the management. [ABSTRACT FROM AUTHOR]

Introduction: Vaginal bleeding is one of the most frequent and potentially serious causes that necessitate emergency consultation during pregnancy. The first trimester is a dynamic period that encompasses ovulation, fertilization, implantation, and organogenesis. Nearly 20-25% of pregnant women experience some degree of bleeding during the early months of gestation. Materials and methods: The study includes all obstetric cases attending department of Obstetrics and Gynecology, Tagore Medical College, Chennai with history of bleeding per vaginum in first trimester from January 2024 to December 2024. Sample size of 200 cases who presented with history of bleeding in first trimester of pregnancy have been included. It is a hospital based prospective study of patients who present with bleeding per vaginum in the first trimester of pregnancy during the study period. Clinical details like age, parity, obstetric history, personal history, medical history, past history, menstrual history and details of present pregnancy in terms of period of amenorrhoea at the time of first episode of bleeding, amount and duration of bleeding whether associated with pain abdomen or not and history of expulsion of fleshy mass /clots were noted. Clinical examination including general physical examination and pelvic examination was done to arrive at a provisional clinical diagnosis. Results: Total obstetric cases was 8416, out of which 200 cases had bleeding per vagina in first trimester (2.37%). The above table shows, majority of them in the age group of 21-25 years constitutes 48%. 60 cases (30%) in 18-20 years, 28 (14%) in 26-30 years, 16 (8%) in 31-35 years. The mean age was 23 years. In the present study, 66 (33%) primigravida and 134 (67%) multigravida. Majority of cases 144 (72%) had uterine size <10 weeks and 32 (16%) between 10- 12 weeks. Cervical os was open in 62(31%) cases and closed in 138 (69%) cases. Fornices was free in 184 (92%) cases and tender in 16 (8%) cases. In the study as per clinical diagnosis, majority of cases, 98 (49%) cases were clinically diagnosed as threatened abortion, 52(26%) cases as incomplete abortion, 18 (9%) cases as missed abortion, 8 (4%) cases as ectopic pregnancy, 14 case as complete abortion, 8 cases as inevitable abortion and 2 cases as molar pregnancy Conclusion: In the present study, USG played a very important role in the diagnosis of cause of first trimester bleeding. It can diagnose threatened abortion positively. Missed abortion, anembryonic gestation and incomplete abortion, ectopic gestation and molar pregnancy are reliably diagnosed. Patient with complete abortions were accurately identified, so that unnecessary curettage was avoided with a consequent reduction in morbidity. Therefore ultrasound diagnosis in first trimester bleeding is a key diagnostic tool. Ultrasonography has helped in establishing the correct diagnosis of clinically misdiagnosed cases, confirm the diagnosis in the others and provide the most appropriate management in all of them. [ABSTRACT FROM AUTHOR]

Choriocarcinoma is an uncommon, highly invasive malignancy arising from the placental trophoblastic tissue. Though staging is clinical, imaging has significant role in the diagnosis, staging, prognostic risk scoring, and management of choriocarcinomas. The purpose of this article is to review the role of multimodality imaging in the diagnosis, staging, and management of choriocarcinomas in correlation with clinicopathologic findings. [ABSTRACT FROM AUTHOR]

To describe clinical outcomes and pearls for patients with gestational trophoblastic neoplasm (GTN). Patients with GTN treated at a referral center from 1/2006 to 12/2022 were included. Clinical characteristics, World Health Organization risk score (low-risk 0–6, high-risk ≥7), and treatments/outcomes were evaluated using summary statistics, stratified by initial treatment at a referral center versus locally. Histologies included complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), choriocarcinoma (CCA), placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). Of 189 patients with GTN, 125 were treated initially at a referral center and 64 locally. Median age at diagnosis was 34 years (range, 17–70). Most patients were White (n = 132, 70 %); 80 patients had CHM, 26 PHM, 52 CCA, 11 PSTT, 19 ETT, and 1 ETT/CCA. For low-risk GTN, first-line treatment was primarily methotrexate, although some were cured with repeat dilation and curettage. For high-risk disease, first-line therapy consisted of multiagent chemotherapy regimens at a referral center (n = 18/18) compared to 7 of 15 patients with high-risk GTN treated with methotrexate at local institutions. Patients with low-risk and high-risk disease who received initial care at a tertiary referral institution had cure rates of 100 % (n = 87/87) and 89 % (n = 16/18), respectively, while patients with initial care locally had cure rates of 87 % (n = 33/37) and 47 % (n = 7/15), respectively. GTN is a rare gynecologic malignancy with high cure rates, particularly in low-risk disease. Treatment consolidation at a tertiary referral institution is critical for improved outcomes, particularly in those with high-risk disease or PSTT/ETT. • Gestational trophoblastic neoplasm (GTN) is a rare gynecologic malignancy. • GTN has high cure rates, particularly in low-risk disease. • Cure rates for high-risk disease and placental site trophoblastic tumor (PSTT)/epithelioid trophoblastic tumor (ETT) vary. • Treatment for patients with high-risk disease and PSTT/ETT requires multi-agent chemotherapy and expertise. • Treatment consolidation at a tertiary referral institution with GTN experience is critical for improved outcomes. [ABSTRACT FROM AUTHOR]

Preeclampsia affects 2% to 8% of pregnancies worldwide and results in significantly high maternal and perinatal morbidity and mortality, with delivery being the only definitive treatment. It is not a single disorder, but rather a manifestation of an insult(s) to the uteroplacental unit —whether maternal, fetal, and/or placental. Multiple etiologies have been implicated, including uteroplacental ischemia, maternal infection and/or inflammation, maternal obesity, sleep disorders, hydatidiform mole, maternal intestinal dysbiosis, autoimmune disorders, fetal diseases, breakdown of maternal-fetal immune tolerance, placental aging, and endocrine disorders. Early- and late-onset preeclampsia are associated with different etiologies: early-onset preeclampsia develops because of poor placentation, while late-onset preeclampsia occurs in women with latent maternal endothelial dysfunction. In preeclamptic placentas, acquired, genetic, and immune risk factors may result in impaired trophoblast invasion and spiral artery remodeling, which affects uteroplacental perfusion. The resulting placental hypoxia affects the heme oxygenase system—a known stress response pathway affected by hypoxia that is important during normal pregnancy and may offer a therapeutic approach in preeclampsia. This review will address the effect of the heme oxygenase/carbon monoxide system on the placenta and preeclampsia. [ABSTRACT FROM AUTHOR]

Abstract Background Placental mesenchymal dysplasia (PMD) is a rare, benign, placental disorder characterised macroscopically by an enlarged multi-cystic placenta. It is a condition associated with a range of reported clinical outcomes and can be misdiagnosed as a molar or partial molar pregnancy given the similarities in clinical presentation. We present an unusual case of PMD complicated by fetal growth restriction and oligohydramnios in the second trimester. Case presentation A 33 year old female was referred to our fetal medicine unit with a multi-cystic placenta at dating scan suspected initially to be a partial molar pregnancy. She opted for conservative management and declined invasive testing. At 16 weeks severe fetal growth restriction was present with an estimated fetal weight

Background & Methods: The aim of the study is to study Ultrasound evaluation of vaginal bleeding in first trimester pregnancy. All ages of the study's patients participated in a prospective, duration-based study. 306 patients admitted to our hospital with history of bleeding in the first trimester of pregnancy in whom ultrasound evaluation was done were studied. Results: In the present study, the most common transvaginal ultrasound finding was RPOC (43.46%) followed by blighted ovum (18.95%). Conclusion: USG played a very important role in the diagnosis of cause of first trimester bleeding. It can diagnose threatened abortion positively. Ectopic, threatened abortion, inevitable abortion and complete molar pregnancy are reliably diagnosed. Patient with complete abortions were accurately identified, so that unnecessary curettage was avoided with a consequent reduction in morbidity. In the present study, 18.95% had Blighted Ovum, 0.98% had Complete Mole, 3.27% had Ectopic, 10.13% had inevitable abortion, 1.96% had Mole, 10.46% had Embryonic demise, 0.65% had Fibroid, 11.11% had Missed abortion, 0.65% had Partial Mole, 0.98% had complete mole, 43.46% had RPOC, 11.76% had Threatened Abortion, 0.98% had USG Inconclusive and 0.33% had Uterine Anomaly. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions To audit outcomes of patients registered in the Queensland Trophoblast Centre (QTC) database who develop resistance to primary chemotherapy. To determine any risk factors that may predict first‐line chemotherapy resistance in patients diagnosed with gestational trophoblastic neoplasia (GTN).Patients within the QTC who were diagnosed with GTN between January 2012 and December 2020 were reviewed.Of 138 patients with GTN registered in the QTC, 22 (15.9%) patients developed resistance to first‐line chemotherapy. Three had high‐risk GTN and 19 had low‐risk GTN. Of the three high‐risk patients, one patient died. This patient had an epithelioid trophoblastic tumour (ETT). The remaining two high‐risk patients had complete hydatidiform moles (CHM) with GTN. Both achieved complete remission with salvage therapy. Of the 19 low‐risk patients, one patient had a partial hydatidiform mole (PHM). This patient achieved remission following third‐line treatment. The other 18 low‐risk patients had CHM with GTN. All but two of these 18 patients were successfully treated with second‐line chemotherapy, with the remaining two patients achieving remission with third‐line chemotherapy. Five of the 18 patients received either actinomycin‐D or methotrexate as salvage therapy. Thirteen patients were given multi‐agent chemotherapy for second‐line treatment. One patient in this group died but this was not due to her disease. Initial β human chorionic gonadotropin levels were not predictive of number of chemotherapy cycles or number of lines of chemotherapy required to achieve remission.GTN is a curable condition. If resistance to first‐line chemotherapy occurred, most patients achieved remission with salvage therapy. [ABSTRACT FROM AUTHOR]

The cost-effectiveness of whole exome sequencing (WES) remains controversial due to variant call variability, necessitating sensitivity and specificity evaluation. WES was performed by three companies (AA, BB, and CC) using reference standards composed of DNA from hydatidiform mole and individual blood at various ratios. Sensitivity was assessed by the detection rate of null–homozygote (N–H) alleles at expected variant allelic fractions, while false positive (FP) errors were counted for unexpected alleles. Sensitivity was approximately 20% for in-house results from BB and CC and around 5% for AA. Dynamic Read Analysis for GENomics (DRAGEN) analyses identified 1.34 to 1.71 times more variants, detecting over 96% of in-house variants, with sensitivity for common variants increasing to 5%. In-house FP errors varied significantly among companies (up to 13.97 times), while DRAGEN minimized this variation. Despite DRAGEN showing higher FP errors for BB and CC, the increased sensitivity highlights the importance of effective bioinformatic conditions. We also assessed the potential effects of target enrichment and proposed optimal cutoff values for the read depth and variant allele fraction in WES. Optimizing bioinformatic analysis based on sensitivity and specificity from reference standards can enhance variant detection and improve the clinical utility of WES. [ABSTRACT FROM AUTHOR]

Gestational Trophoblastic Neoplasia (GTN) presents various trophoblastic tissue abnormalities, from benign hydatidiform mole to malignant choriocarcinoma. Here, we report a rare case of a 26-year-old woman with a history of three consecutive early gestational miscarriages. Symptoms included vaginal bleeding, dyspnoea, and abdominal pain. Radiological findings showed widespread metastasis to the lungs, vagina, liver, spleen, and kidneys, indicating aggressive choriocarcinoma. Biopsy confirmed the diagnosis, revealing highly atypical trophoblastic cells with extensive vascular invasion. Despite aggressive treatment involving chemotherapy, surgical resection, and supportive care, the patient's prognosis remains guarded, with persistent metastases. This case underscores the complexity of managing advanced GTN with multifocal metastases, requiring a tailored multidisciplinary approach. It also emphasizes the importance of suspecting GTN in women with recurrent miscarriages for timely intervention and improved outcomes. [ABSTRACT FROM AUTHOR]

Background/Objectives: Female infertility due to unexpected causes exhibits a great challenge for both clinicians and women who are trying to conceive. The present clinical case series study aimed to evaluate the efficacy of multiple wavelengths of red and near-infrared (NIR) laser photobiomodulation (PBM) for increasing the potential of fertility in women and improving reproductive health in unexplained infertility issues. The objectives were to assess the following: (1) any adverse effects; (2) the possibility of producing an effective PBM protocol; (3) and healthy live birth. The inclusion criteria were to related to females who failed to conceive naturally beyond two years, multiple miscarriages, molar pregnancy, non-viable embryos from in vitro fertilisation (IVF) cycles, and failure to complete successful implantation of viable pre-implantation genetic tested (PGT-A) embryos. Methods: Case series of three female subjects with unexplained age-related infertility issues, which included a failure to conceive naturally beyond two years, multiple miscarriages, molar pregnancy, non-viable embryos from IVF cycles, and failure to complete successful implantation of viable pre-implantation genetic tested (PGT-A) embryos. In each case, previous conditions were recorded and then compared with outcomes after the patient received a course of PBM treatments. In every case, fertility outcomes improved. Three cases resulted in a full-term pregnancy and the birth of a healthy baby. PBM treatments were given at weekly and/or at two-week intervals using IR and NIR wavelengths between 600 nm and 1000 nm in the lead up to natural conception, IVF oocyte retrieval, blastocyst/embryo implantation, and/or the production of viable embryos. Results: In every case, fertility outcomes improved. Improvements in reproductive health outcomes in each case give reason to suggest that PBM may help to improve unexplained age-related infertility. Conclusions: Our study demonstrated that multiwavelength of red and NIR PBM with either an LED or laser, or a combination, improved female fertility and reproductive health and contributed to healthy live births in females diagnosed with unexplained age-related infertility. Extensive studies with robust data are warranted to validate our PBM dosimetry and treatment protocols. Moreover, understanding the genetic and phenotype biomarkers is important to standardise a range of PBM light dosimetry. [ABSTRACT FROM AUTHOR]

Aims: Diagnostic separation of diandric triploid gestation, i.e. partial mole from digynic triploid gestation, is clinically relevant, as the former may progress to postmolar gestational trophoblastic neoplasia. The aim of the study was to investigate if the combination of abnormal histology combined with ploidy analysis‐based triploidy is sufficient to accurately diagnose partial mole. Methods and Results: A genotype–phenotype correlation study was undertaken to reappraise histological parameters among 20 diandric triploid gestations and 22 digynic triploid gestations of comparable patient age, gestational weeks, and clinical presentations. Two villous populations, irregular villous contours, pseudoinclusions, and syncytiotrophoblast knuckles, were common in both groups. Villous size ≥2.5 mm, cistern formation, trophoblastic hyperplasia, and syncytiotrophoblast lacunae were significantly more common in the partial hydatidiform mole. Cistern formation had the highest positive predictive value (PPV) (93%) and highest specificity (96%) for diandric triploid gestation, although the sensitivity was 70%. Cistern formation combined with villous size ≥2.5 mm or trophoblast hyperplasia or syncytiotrophoblast lacunae had 100% specificity and PPV, but a marginal sensitivity of 60%–65%. A moderate interobserver agreement (Kappa = 0.57, Gwet's AC1 = 0.59) was achieved among four observers who assigned diagnosis of diandric triploid gestation or digynic triploidy solely based on histology. Conclusions: None of histological parameters are unique to either diandric triploid gestation or digynic triploid gestation. Cistern formation is the most powerful discriminator, with 93% PPV and 70% sensitivity for diandric triploid gestation. While cistern formation combined with either trophoblastic hyperplasia or villous size ≥2.5 mm or syncytiotrophoblast lacunae has 100% PPV and specificity for diandric triploid gestation, the sensitivity is only 60% to 65%. Therefore, in the presence of triploidy, histological assessment is unable to precisely classify 35% to 40% of diandric triploid gestations or partial moles. [ABSTRACT FROM AUTHOR]

Multiple placental cysts are a common finding in obstetric ultrasound imaging. Although they have benign differential diagnoses, such as hydropic degeneration of the placenta or placental mesenchymal dysplasia, it's important to consider significant pathologies, such as benign gestational trophoblastic disease or hydatidiform mole. A challenging issue in obstetrics is pregnancies with a placenta that has a bipartite texture. This means that one side of the placenta is normal, but the other side is full of cystic formations, and only one fetus is visualized. The main critical concern is the presence of a molar pregnancy because of its catastrophic consequences. Here, we report a rare case in which the gravid uterus had a normal diploid fetus but had a bipartite placenta, which was triploid in the hydropic part, revealing a unique genetic pattern. [ABSTRACT FROM AUTHOR]

Background Pregnancy represents an additional challenge to the complex clinical picture of lipodystrophy disorders, and the management of such conditions with related comorbidities has been underreported. This work aims to outline the risk associated with a pregnancy event for women dealing with acquired partial lipodystrophy and the need for diverse but specialized care. Case We report on the successful pregnancy outcome of a 28-year-old woman with an acquired partial form of lipodystrophy related to an allogenic bone marrow transplant that occurred at pediatric age. Although metabolic control was challenging, glucose levels progressively improved during the pregnancy, and triglycerides increased less than expected. The periodic monitoring of leptin levels showed a progressive increase with a peak in the third trimester (41.53 ng/mL), followed by a fast decline the day after giving birth, with a lower basal level than the prepregnancy period. However, preterm delivery occurred associated with cardiac complications in the mother. Results A total of 12 studies were retrieved concerning women aged 14 to 38 years with various lipodystrophy phenotypes. Diabetes and hypertriglyceridemia were the most common comorbidities. Most women had successful pregnancies despite gestational complications (including miscarriages), preterm and emergency deliveries, and newborns undergoing partum or postpartum transient or chronic complications. Conclusion Lipodystrophy disorders expose both mothers and children to very high risk. Intensive monitoring and care of all potential clinical complications should be planned and carried out by a multidisciplinary team before, during, and after the pregnancy. Leptin secretion during pregnancy should be investigated more deeply in these patients. [ABSTRACT FROM AUTHOR]

Introduction: A molar pregnancy coexisting with a normal fetus is a very rare occurrence. It can present as a complete mole with a normal fetus or a partial mole with a normal fetus. There is paucity of data on optimal management of such patients who have this presentation, which mostly ends with a poor prognosis. Case presentation: We present a case of 26-year-old woman of African descent, a para 1 + 0 gravida 2, who came with a compete molar pregnancy coexisting with a normal fetus in the second trimester and the complexity of her management. Patient presented in second trimester for an anomaly scan, in which the complete mole coexisting with a normal fetus was diagnosed. The molar pregnancy was also covering the cervical os. The patient was advised to terminate the pregnancy due to the risk of massive hemorrhage, but she was keen on continuing with the pregnancy. She was admitted two times with bleeding and in the last admission she also had chorioamnionitis, which warranted a hysterotomy at 25 weeks 1 day. Patient made a good recovery, unfortunately the neonate had an early neonatal death at a different facility due to respiratory complications. Conclusion: In this case a patient with a normal fetus coexisting with a complete mole and complete previa was closely monitored, but a hysterotomy was done at 25 weeks 1 day gestation due to chorioamnionitis. The diagnosis was made by ultrasound, in which there was a snowstorm appearance of one of the gestational sacs while the other sac had a normal fetus. This is a rare entity that puts the doctor in a dilemma due to potential maternal and fetal complications. The take-home message is that a patient who presents with a complete mole and a coexisting normal fetus can be supported to a viability stage. Chorioamnionitis interfered with the continuation of this pregnancy. [ABSTRACT FROM AUTHOR]

Background: Placental mesenchymal dysplasia (PMD) is a rare, benign, placental disorder characterised macroscopically by an enlarged multi-cystic placenta. It is a condition associated with a range of reported clinical outcomes and can be misdiagnosed as a molar or partial molar pregnancy given the similarities in clinical presentation. We present an unusual case of PMD complicated by fetal growth restriction and oligohydramnios in the second trimester. Case presentation: A 33 year old female was referred to our fetal medicine unit with a multi-cystic placenta at dating scan suspected initially to be a partial molar pregnancy. She opted for conservative management and declined invasive testing. At 16 weeks severe fetal growth restriction was present with an estimated fetal weight < 3rd centile and associated with oligohydramnios. Whilst live births in cases of PMD have been reported in the literature, to our knowledge there are no reported successful outcomes in cases of early onset growth restriction at this gestation. The patient opted to proceed with termination of pregnancy given the suspected poor prognosis. Post mortem results confirmed a diagnosis of PMD and fetal growth restriction with normal genetic testing. Conclusions: Placental mesenchymal dysplasia can be a difficult condition to manage, particularly when counselling about prognosis and deciding whether to continue the pregnancy. More evidence is needed about prognostic factors in PMD associated with a successful outcome. Early onset fetal growth restriction and/or oligohydramnios prior to 20 weeks are likely poor prognostic factors which should be considered in the antenatal counselling. [ABSTRACT FROM AUTHOR]

The article discusses a case of gestational trophoblastic neoplasia (GTN) in a cesarean scar following a hydatidiform mole. The patient underwent surgery and chemotherapy, with successful outcomes and no signs of recurrence. The management of GTN in cesarean scar sites presents challenges due to the lack of standardized guidelines, highlighting the importance of multidisciplinary collaboration in such cases. Surgical intervention may be necessary for high-risk or chemotherapy-resistant cases, emphasizing the need for individualized treatment approaches. [Extracted from the article]

To identify novel genes responsible for recurrent hydatidiform moles (HMs), we performed exome sequencing on 75 unrelated patients who were negative for mutations in the known genes. We identified biallelic deleterious variants in 6 genes, FOXL2, MAJIN, KASH5, SYCP2, MEIOB, and HFM1, in patients with androgenetic HMs, including a familial case of 3 affected members. Five of these genes are essential for meiosis I, and their deficiencies lead to premature ovarian insufficiency. Advanced maternal age is the strongest risk factor for sporadic androgenetic HM, which affects 1 in every 600 pregnancies. We studied Hfm1-/- female mice and found that these mice lost all their oocytes before puberty but retained some at younger ages. Oocytes from Hfm1-/- mice initiated meiotic maturation and extruded the first polar bodies in culture; however, their meiotic spindles were often positioned parallel, instead of perpendicular, to the ooplasmic membrane at telophase I, and some oocytes extruded the entire spindle with all the chromosomes into the polar bodies at metaphase II, a mechanism we previously reported in Mei1-/- oocytes. The occurrence of a common mechanism in two mouse models argues in favor of its plausibility at the origin of androgenetic HM formation in humans. [ABSTRACT FROM AUTHOR]

Introduction: Prophylactic chemotherapy (PC) has been suggested to be effective in prevention of post molar gestational trophoblastic neoplasia (PGTN) in patients with high-risk molar pregnancies. The goal of this study is to assess the efficacy of single dose methotrexate as PC in terms of spontaneous remission, time to remission, and progression to PGTN. Materials and methods: Patients with molar pregnancy were recruited to the study and underwent cervical dilation and suction curettage. Patients who had pathologically proven complete hydatidiform mole were evaluated with abdominal ultrasonography to confirm complete evacuation and absence of remnants. These patients were allocated to two groups: group one received Methotrexate 50 mg/m2 via intramuscular injection, while group two did not. PGTN was defined according to the 2018 FIGO criteria. For patients with confirmed PGTN, the following variables were recorded: occurrence of metastasis, resistance to first-line chemotherapy and time to βHCG level normalization. Results: Eighty patients were enrolled to the study, of which 22 cases (27.5%) received PC. It was found that PC with MTX did not significantly influence spontaneous remission (18 (81.8%) Vs 37 (63.7%), p value: 0.12) or time to remission (57 ± 22.5 Vs 61.24 ± 21.78 days, p value: 0.46) in high-risk molar pregnancies. Moreover, among patients in PC group and control group, 4 cases (18.2%) and 21 patients (36.3%) progressed to PGNT, respectively (p value: 0.12). Although patients in PC group tended to be diagnosed in lower stages compared to patients in control group, this difference was insignificance (p value: 0.95). Among patients who developed to PGTN, PC did not reduce the frequency of metastatic disease, resistance to first-line chemotherapy, or the time interval to serum βHCG level normalization (all p values > 0.05). Conclusion: This study suggests that a single-dose MTX as PC may not be an effective therapeutic option for preventing PGTN in patients with high-risk molar pregnancy. [ABSTRACT FROM AUTHOR]

A complete hydatidiform mole (CHM) is a common disease and is known to develop post-molar gestational trophoblast neoplasia (GTN). However, the molecular mechanisms underlying the progression of CHM to post-molar GTN remain largely unknown. In this study, we investigated the molecular factors associated with the progression using RNA-seq. We included 13 patients with CHM and performed RNA-seq using freshly frozen samples. We identified differentially expressed genes between patients who developed GTN (GTN group) and those who achieved spontaneous remission after uterine evacuation (SR group), and performed pathway analysis. Then, functional analyses were performed on choriocarcinoma (JAR and JEG-3) and CHM (Hmol1-3B and Hmol1-2C) cells. Moreover, we evaluated the in vivo tumorigenicity of XBP1 -overexpressed Hmol1-3B cells. The gene expression profiles were separated into two groups, and an upstream regulator analysis was performed using 281 differentially expressed genes. We focused on transcription factors and identified that 33 transcription factors were activated in the GTN group. Then, excluding those with low expression levels in clinical samples and cell lines, XBP1 was selected for further analysis. Additionally, XBP1 downregulation significantly decreased the migration and invasive abilities of choriocarcinoma cells, whereas XBP1 overexpression significantly increased the migration and invasive abilities of CHM cells. Furthermore, animal experiments showed that tumor weight and blood human chorionic gonadotropin (hCG) levels were significantly higher in the XBP1 -overexpressing Hmol1-3B-bearing mice than those in the control mice. RNA-seq identified XBP1 as a key factor in post-molar GTN, suggesting it contributes to the development of post-molar GTN. • RNA-seq and pathway analysis suggested that XBP1 was associated with the development of post-molar GTN. • XBP1 contributed to the migration and invasive abilities of CHM and choriocarcinoma cells. • The overexpression of XBP1 increased the in vivo tumorigenicity in Hmol1-3B-bearing mice. [ABSTRACT FROM AUTHOR]

The proper evaluation of abortion specimens and placentas from stillbirth and post-partum cases is important for adequate clinical care of post-abortion and post-partum patients. The following topics will be reviewed: (1) the importance of evaluation of both fetal and placental tissue in first trimester abortions to confirm an intrauterine pregnancy versus an ectopic pregnancy; (2) the clinical history associated with an abortion specimen or retained products of conception (POC) influences how the pathologist should triage the specimen; (3) the criteria for diagnosis of a molar pregnancy, which is critical for clinicians to know which patients need follow-up; (4) the utility of genetic studies for both diagnosis and appropriate follow-up of the patient; and (5) the pathologic evaluation of specimens from patients with post-partum hemorrhage for placenta accreta spectrum and subinvolution of maternal vessels. [ABSTRACT FROM AUTHOR]

Purpose: This study was presented to investigate the clinical–pathological characteristics of gestational trophoblastic neoplasia (GTN) following non-molar pregnancy and differentiated with ectopic pregnancy (EP). Methods: The clinical data of 83 patients who were admitted for suspected GTN after non-molar pregnancy at the Women's Hospital School of Medicine Zhejiang University from January 2015 to September 2022 were selected for analysis. Results: In total, 41 cases were confirmed non-molar GTN, including 31 choriocarcinoma, 9 PSTT (placental site trophoblastic tumor), and 1 ETT (epithelioid trophoblastic tumor), while 42 cases were confirmed EP. Compared with ectopic pregnancy, non-molar GTN patients had lower levels of serum progesterone compared with EP (3.81 nmol/L vs 17.70 nmol/L, P = 0.001). Based on the ultrasound, the thickness of the endometrium was thinner in patients with non-molar GTN compared with EP (0.565 cm vs 0.70 cm, P = 0.018). By histopathologic examination, the endothelium of non-molar GTN showed less decidual-like changes compared with EP (64.3% vs 14.6%, P = 0.001). Conclusion: A combination of serum progesterone levels, endometrium thickness, and histopathologic features of the endometrium can help to differentiate non-molar GTN and EP. Surgeries including hysteroscopy with curettage and/or laparoscopy are needed. [ABSTRACT FROM AUTHOR]

Gestational trophoblastic disease (GTD) refers to a group of pregnancy-related tumors that are recognized as the most curable gynecologic malignancies. Diagnosing GTD can be challenging, particularly after a non-molar pregnancy, due to its various presentations, which may mimic retained products with hypervascularity or arteriovenous malformation. Human chorionic gonadotropin (HCG) serves as an excellent biomarker for monitoring disease progression, response to treatment, and post-treatment surveillance. A plateaued or rising HCG level can facilitate the early detection of progression from complete or partial hydatidiform mole to GTD. Here, we present a case series involving six patients with GTD who initially presented with elevated beta-HCG levels and abnormal bleeding. Of these six patients, five were initially diagnosed with hypervascular retained products following a first-trimester abortion and underwent surgical evacuation. However, due to persistently elevated beta-HCG levels and evidence of myometrial invasion, the diagnosis was later revised to GTD. All patients were successfully managed with chemotherapy. Methotrexate, as a first-line treatment, is effective in achieving complete remission in most non-metastatic and low-risk cases. It has minimal severe toxicity, excellent cure rates, and does not appear to affect fertility. In summary, gestational trophoblastic diseases represent a diagnostic conundrum for clinicians due to their diverse presentations and potential for mimicking other conditions. Nevertheless, when these diseases are identified and managed in a timely manner, the prognosis is highly favorable, underscoring the importance of vigilant monitoring and early intervention. [ABSTRACT FROM AUTHOR]

Introduction: The coexistence of a complete hydatidiform mole with twin live fetuses in a triplet pregnancy is an extremely rare condition with an unknown incidence. Case Report: This report presents a case of a dichorionic diamniotic triplet pregnancy complicated by the coexistence of a complete hydatidiform mole and twin live fetuses. The pregnancy resulted in a preterm delivery at 30 weeks and 5 days of gestation, with both live fetuses surviving to date. During the pregnancy, the patient was diagnosed with pre-eclampsia and intrahepatic cholestasis. Post-delivery, she was found to have an invasive mole with lung metastases, which was ultimately successfully treated. Conclusion: This report highlights critical considerations for managing a multiple pregnancy complicated by a complete hydatidiform mole, alongside the associated potential complications. In light of the limited literature on the clinical management of this condition, our findings offer valuable insights into navigating the risks and optimizing patient outcomes. [ABSTRACT FROM AUTHOR]

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Abstract Background Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic’s impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported. Methods In-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women’s access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic. Results All women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal. Conclusions These findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss.

Background: Chromogenic in situ hybridization (CISH) and immunohistochemistry analysis for p57 are ancillary studies discriminating partial hydatidiform mole (PHM), complete hydatidiform mole (CHM), and non-molar hydropic abortion (HA). Objective: It aimed to study CISH with a probe to chromosome 17 (CISH17) and chromosome 2 (CISH2) discriminating chromosomal ploidy of PHM, CHM, and HA; in addition, their surrogacy value in the evaluation of triploid and diploid in product of conception specimens (POCs) was evaluated. Materials and Methods: 44 statistically significant POCs were selected retrospectively. The Kappa agreement coefficients, sensitivity, specificity, and accuracy with 95% confidence interval (95% CI) were reported. Results: PHM, CHM, and HA were diagnosed to be 23, 17, and 3 cases based on both CISH2 and CISH17 resulting in their complete discrimination between PHM and HA (23 vs. 3). The Kappa agreement coefficient was 95.4% (p < 0.001) when diagnosing the PHM (23), CHM (20), and HA (1). In addition, the accuracy, sensitivity, and specificity were 95.26% (95% CI: 84.25-99.38), 100% (95% CI: 85.18-100), and 95% (95% CI: 76.18-99.88), respectively. The power analysis on CISH2 and CISH17 tests discriminating between triploid and diploid in POCs was estimated to be 100%. Conclusion: Based on the current finding, CISH2 and CISH17 enjoyed perfect agreement in diagnosing chromosomal ploidy; in addition, their absolute power discriminating between triploid and diploid revealed that they could be used as surrogate markers for ploidy. Prospective studies on fresh specimens are suggested comparing the CISH method's accuracy with flow cytometry karyotyping and fluorescence in situ hybridization. [ABSTRACT FROM AUTHOR]

Capillary blood collection, a technique traditionally used in diabetes care, shows promise for many applications including pregnancy monitoring. Serial measurement of serum human Chorionic Gonadotrophin (hCG) is frequently necessary for managing early pregnancy, including molar pregnancy, requiring multiple visits to a maternity hospital for blood collection by venepuncture. This proof-of-concept study aimed to assess the clinical performance and user acceptability of capillary blood samples collected remotely, as an alternative to venous blood for hCG measurement. Women attending the early pregnancy unit who required serum hCG measurement, were invited to participate. Following informed written consent, participants were shown how to collect capillary blood samples using the Mini-Collect® collection device. Matched venous and capillary blood samples were collected in clinic for hCG comparison purposes. Participants were also supplied with a home collection kit in a prepaid return envelope. They were asked to perform a finger-prick blood collection at home using the instructions provided and to return the capillary blood sample by post within 24 h of collection, along with a completed user-satisfaction questionnaire. Statistical analysis was performed using Analyse-it® software. The study enrolled 71 participants and over a third of these women collected a capillary blood sample at home. The median age of participants was 33 years (range 29–36). Passing-Bablok linear regression (y = -0.037 + 1.04x) and Spearman correlation (r = 0.999, p < 0.0001), demonstrated good agreement and strong correlation between venous and capillary samples, over a broad range of hCG values (1.2 to 224,0000 IU/L). The majority of capillary samples collected remotely (39%, 27/69) had sufficient blood volume for analysis (74%, 20/27). Respondents (77%, 18/25) found the collection device easy to use and expressed willingness to use a future service if available (80%, 20/25) The study demonstrated excellent agreement between the hCG results obtained from both collection methods, suggesting that capillary blood can serve as a reliable alternative for venous hCG measurement, particularly in clinical settings requiring frequent hCG monitoring. Feedback from the study questionnaire indicates a preference for this type of follow-up among women, indicating potential improvements in compliance for blood based diagnostic tests. [ABSTRACT FROM AUTHOR]

IVF laboratories routinely adopt morphological pronuclear assessment at the zygote stage to identify abnormally fertilized embryos deemed unsuitable for clinical use. In essence, this is a pseudo-genetic test for ploidy motivated by the notion that biparental diploidy is required for normal human life and abnormal ploidy will lead to either failed implantation, miscarriage, or significant pregnancy complications, including molar pregnancy and chorionic carcinoma. Here, we review the literature associated with ploidy assessment of human embryos derived from zygotes displaying a pronuclear configuration other than the canonical two, and the related pregnancy outcome following transfer. We highlight that pronuclear assessment, although associated with aberrant ploidy outcomes, has a low specificity in the prediction of abnormal ploidy status in the developing embryo, while embryos deemed abnormally fertilized can yield healthy pregnancies. Therefore, this universal strategy of pronuclear assessment invariably leads to incorrect classification of over 50% of blastocysts derived from atypically pronucleated zygotes, and the systematic disposal of potentially viable embryos in IVF. To overcome this limitation of current practice, we discuss the new preimplantation genetic testing technologies that enable accurate identification of the ploidy status of preimplantation embryos and suggest a progress from morphology-based checks to molecular fertilization check as the new gold standard. This alternative molecular fertilization checking represents a possible non-incremental and controversy-free improvement to live birth rates in IVF as it adds to the pool of viable embryos available for transfer. This is especially important for the purposes of 'family building' or for poor-prognosis IVF patients where embryo numbers are often limited. [ABSTRACT FROM AUTHOR]

Thyrotoxicosis during pregnancy is rare but can have severe adverse consequences for the mother or foetus if left undiagnosed and untreated. It can be caused by an underlying thyroid disease or develop as gestational transient thyrotoxicosis. Molar pregnancy stands out as a pathological condition characterized by abnormal trophoblastic cell growth, which can manifest in benign or malignant forms, and is diagnosed with a disproportionate elevation of β‐hCG (beta‐human chorionic gonadotrophin) and specific features on ultrasonography including absent sac and large multicystic or honeycomb appearance. A pronounced increase in β‐hCG levels can trigger hyperthyroidism, due to the structural resemblance between β‐hCG and thyroid‐stimulating hormone (TSH), although the thyrotrophic effects of β‐hCG could vary between patients diagnosed with gestational trophoblastic disease (GTD). In this report, we present two cases (Patient 1: 43 years, Patient 2: 31 years) who came to emergency department following a history of vaginal spotting, palpitations, and hyperemesis. In both patients, blood tests indicated disproportionately elevated β‐hCG levels along with high levels of Free T4 (FT4) and Free T3 (FT3), as well as suppressed TSH levels. Ultrasonography showed nonviable products of conception with large multicystic hemorrhagic lesions and empty gestational sacs, thereby confirming GTD. The Burch–Wartofsky Point Scale scores were 20 and 15 points, respectively, suggesting that they were less likely to be in thyroid storm at presentation. Antithyroid medications were administered, followed by evacuation of the products of conception. Postoperatively, their thyroid function was normalized. These cases underscore the importance of ruling out thyroid storm, monitoring thyroid function, and treating hyperthyroidism appropriately before undergoing surgical treatment. It is also important to consider the variability in the thyrotrophic effects of β‐hCG among individuals diagnosed with GTD. In addition to monitoring free thyroid hormone levels, it is crucial to consider clinical symptoms to effectively manage such cases. [ABSTRACT FROM AUTHOR]

Gestational trophoblastic diseases (GTDs) encompass a spectrum of conditions characterized by abnormal trophoblastic cell growth, ranging from benign molar pregnancies to malignant trophoblastic neoplasms. This systematic review explores the molecular underpinnings of GTDs, focusing on genetic and epigenetic factors that influence disease progression and clinical outcomes. Based on 71 studies identified through systematic search and selection criteria, key findings include dysregulations in tumor suppressor genes such as p53, aberrant apoptotic pathways involving BCL-2 (B-cell lymphoma), and altered expression of growth factor receptors and microRNAs (micro-ribose nucleic acid). These molecular alterations not only differentiate molar pregnancies from normal placental development but also contribute to their clinical behavior, from benign moles to potentially malignant forms. The review synthesizes insights from immunohistochemical studies and molecular analyses to provide a comprehensive understanding of GTD pathogenesis and implications for personalized care strategies. [ABSTRACT FROM AUTHOR]

Background: Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic's impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported. Methods: In-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women's access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic. Results: All women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal. Conclusions: These findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss. [ABSTRACT FROM AUTHOR]

Choriocarcinoma can be gestational and nongestational. Gestational choriocarcinoma is rare with an incidence of 9.2 in 40,000 pregnancies in Asian population. They can occur following molar, partial molar pregnancy, abortion, or delivery. It is detected by elevated levels of serum beta-human chorionic gonadotropin (beta-hCG) and by imaging modality. The need for histopathological diagnosis for choriocarcinoma is debatable. Six cases of choriocarcinoma are described with variable presentations and outcomes. Out of six cases, three were following vaginal delivery, two were after abortion, and one case was perimenopausal with antecedent pregnancy 10 years ago, unclear whether it was the cause for choriocarcinoma. Brain and lung metastasis were seen in three cases each; one case, which had metastasis to all organs, had worse prognosis and succumbed to the disease. All belonged to high-risk group according to International Federation of Gynaecology and Obstetrics score (8–13). The prognosis is usually very good, provided that prompt diagnosis and treatment are initiated early. Long-term follow-up with beta-hCG levels needs to be done to detect recurrence but it did not act like a prognostic indicator in our case series. [ABSTRACT FROM AUTHOR]

Background & Objective: Pregnancy in women diagnosed with Type-1 diabetes mellitus poses a higher risk of experiencing complications related to the health of the fetus, the mother, and the newborn, along with potential obstetric issues. The objective of this study was to examine the maternal and fetal outcomes, as well as complications faced by pregnant women with type-1 diabetes, and to identify potential preventable factors. Methods: This retrospective cohort study, conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University, Karachi, Pakistan (January 2022 - January 2023), focused on registered pregnancies of women with Type-1 diabetes. A predesigned questionnaire recorded demographic information, diabetes and obstetric history, clinical details, treatment specifics, maternal, perinatal, and neonatal outcomes. Results: This study included 100 women with pre-existing Type-1 diabetes (mean age: 15.11 ± 5.64 years at diabetes diagnosis). Of these, 72% reported unplanned pregnancies, with a mean HbA1C at conception 8.29%. Median gestational age at delivery was 32.15 ± 10.82 weeks. Delivery outcomes included 40% normal vaginal deliveries and 60% C-sections (9% emergency, 51% elective). Stillbirths occurred in 14 cases, while 16 women experienced one miscarriage, seven had two, and 10 had three miscarriages. Glycemic targets (fasting) were achieved in 55 women, and post-meal targets only in 29, whereas, neonatal complications included hypoglycemia in 13 and low birth weight in 12 neonates. Conclusion: The high frequency of unplanned pregnancies and cesarean sections along with poor management of prepregnancy care and poor glycemic control results in compromised maternal and perinatal outcomes in this high-risk group. [ABSTRACT FROM AUTHOR]

Introduction: Intraosseous lipomas (IL) are rare benign neoplasms of bone which very rarely occur in the facial bones such as the mandible. Of the documented cases, many are often asymptomatic and consequently, are an incidental finding discovered by the practitioner. Case Report: The following case report recounts a 22‐year‐old patient referred for extraction of a carious molar at an Oral and Maxillofacial unit with an incidental finding of pathology involving the contralateral lower left wisdom tooth (LL8) on radiographic examination. Further investigations showed associated external root resorption of the lower left wisdom tooth and a provisional diagnosis of a radicular cyst was made. The case was managed by extracting the associated tooth and enucleating the lesion. During the procedure, fatty tissue was curetted at the apex instead of the expected cystic content. Subsequent histopathology confirmed the diagnosis of an IL. Conclusion: To the authors' knowledge, this is only the second documented case of an IL associated with tooth resorption. Findings from this case further our knowledge of the relatively uncommon pathology of intraosseous lipomas in the mandible and highlight the need for histopathological documentation and reporting of apical lesions. [ABSTRACT FROM AUTHOR]

Background: Anaemia during pregnancy is common worldwide. In Australia, approximately 17% of non-pregnant women of reproductive age have anaemia, increasing to a rate of 25% in pregnant women. This study sought to determine the rate of screening for anaemia in pregnancy in regional New South Wales, and to determine whether screening and treatment protocols followed the recommended guidelines. Methods: This retrospective study reviewed antenatal and postnatal (48 h) data of women (n = 150) who had a live birth at Bathurst Hospital between 01/01/2020 and 30/04/2020. Demographic data, risk factors for anaemia in pregnancy, antenatal bloods, treatments provided in trimesters one (T1), two (T2) and three (T3), and postpartum complications were recorded. These were compared to the Australian Red Cross Guidelines (ARCG) using descriptive statistics. Results: Of the women with screening data available (n = 103), they were mostly aged 20-35yrs (79.6%), 23.3% were obese, 97.1% were iron deficient, 17% were anaemic and only a few (5.3%) completed the full pregnancy screening as recommended by the ARCG while a majority completed only partial screenings specifically Hb levels in T1 (56.7%), T2 (44.7%) and T3 (36.6%). Compliance to oral iron was largely undocumented, but constipation was a common side effect among the women. IV iron was administered in 14.0% of women, approximately 1.75x higher than the recommended rate. Conclusions: This study provided useful information about compliance to screening and treatment guidelines for anaemia in pregnancy. We identified the need for improved documentation and communication between various health providers to ensure adequate antenatal care to prevent maternal complications during pregnancy. This will improve patient care and encourage further developments in maternal care, bridging the rural health gap. [ABSTRACT FROM AUTHOR]

Background/Aims: Molar pregnancy is a rare complication of pregnancy. Patients face surgery, human chorionic gonadotropin monitoring and potentially systemic treatment, resulting in unique support needs. This study's aim was to explore the impacts of gestational trophoblastic disease on embodied and emotional experience. Methods: This qualitative study considered stories of molar pregnancy from 20 women in the UK, US, Canada and Australia. These were drawn from 18 publicly available online blogs and eight semi-structured interviews, and analysed thematically. Results: Three themes were developed: 'loss', describing women's responses to their pregnancy ending; 'isolation', comprising 'rarity', 'lack of awareness' and support seeking; and 'alienation', capturing the unfamiliarity of diagnosis, 'failure' and barriers to 'moving forward'. Conclusions: Experiences are shaped by wider narratives of 'typical' pregnancy. Patient care requires an individualised and responsive approach, and non-specialist practitioners should feel confident in discussing molar pregnancy and have access to up-to-date guidance. [ABSTRACT FROM AUTHOR]

Although trophoblastic diseases were frequent in East Asia in the past, choriocarcinoma is rare at present after the introduction of effective chemotherapy and postmolar management in Japan. Molar pregnancy has also decreased, possibly due to ultrasound diagnosis and termination in early pregnancy. The outcome of the disease has greatly improved by ultrasound diagnosis, including real-time B-mode, color/power Doppler flow images, and pulsed Doppler tumor blood flow studies. [ABSTRACT FROM AUTHOR]

Objective: To compare the predictive performance of three different mathematical models for first‐trimester screening of pre‐eclampsia (PE), which combine maternal risk factors with mean arterial pressure (MAP), uterine artery pulsatility index (UtA‐PI) and serum placental growth factor (PlGF), and two risk‐scoring systems. Methods: This was a prospective cohort study performed in eight fetal medicine units in five different regions of Spain between September 2017 and December 2019. All pregnant women with singleton pregnancy and a non‐malformed live fetus attending their routine ultrasound examination at 11 + 0 to 13 + 6 weeks' gestation were invited to participate in the study. Maternal characteristics and medical history were recorded and measurements of MAP, UtA‐PI, serum PlGF and pregnancy‐associated plasma protein‐A (PAPP‐A) were converted into multiples of the median (MoM). Risks for term PE, preterm PE (< 37 weeks' gestation) and early PE (< 34 weeks' gestation) were calculated according to the FMF competing‐risks model, the Crovetto et al. logistic regression model and the Serra et al. Gaussian model. PE classification was also performed based on the recommendations of the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG). We estimated detection rates (DR) with their 95% CIs at a fixed 10% screen‐positive rate (SPR), as well as the area under the receiver‐operating‐characteristics curve (AUC) for preterm PE, early PE and all PE for the three mathematical models. For the scoring systems, we calculated DR and SPR. Risk calibration was also assessed. Results: The study population comprised 10 110 singleton pregnancies, including 32 (0.3%) that developed early PE, 72 (0.7%) that developed preterm PE and 230 (2.3%) with any PE. At a fixed 10% SPR, the FMF, Crovetto et al. and Serra et al. models detected 82.7% (95% CI, 69.6–95.8%), 73.8% (95% CI, 58.7–88.9%) and 79.8% (95% CI, 66.1–93.5%) of early PE; 72.7% (95% CI, 62.9–82.6%), 69.2% (95% CI, 58.8–79.6%) and 74.1% (95% CI, 64.2–83.9%) of preterm PE; and 55.1% (95% CI, 48.8–61.4%), 47.1% (95% CI, 40.6–53.5%) and 53.9% (95% CI, 47.4–60.4%) of all PE, respectively. The best correlation between predicted and observed cases was achieved by the FMF model, with an AUC of 0.911 (95% CI, 0.879–0.943), a slope of 0.983 (95% CI, 0.846–1.120) and an intercept of 0.154 (95% CI, –0.091 to 0.397). The NICE criteria identified 46.7% (95% CI, 35.3–58.0%) of preterm PE at 11% SPR and ACOG criteria identified 65.9% (95% CI, 55.4–76.4%) of preterm PE at 33.8% SPR. Conclusions: The best performance of screening for preterm PE is achieved by mathematical models that combine maternal factors with MAP, UtA‐PI and PlGF, as compared to risk‐scoring systems such as those of NICE and ACOG. While all three algorithms show similar results in terms of overall prediction, the FMF model showed the best performance at an individual level. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The diagnosis of failure to progress, the most common indication for intrapartum cesarean delivery, is based on the assessment of cervical dilation and station over time. Labor curves serve as references for expected changes in dilation and fetal descent. The labor curves of Friedman, Zhang et al, and others are based on time alone and derived from mothers with spontaneous labor onset. However, labor induction is now common, and clinicians also consider other factors when assessing labor progress. Labor curves that consider the use of labor induction and other factors that influence labor progress have the potential to be more accurate and closer to clinical decision-making. This study aimed to compare the prediction errors of labor curves based on a single factor (time) or multiple clinically relevant factors using two modeling methods: mixed-effects regression, a standard statistical method, and Gaussian processes, a machine learning method. This was a longitudinal cohort study of changes in dilation and station based on data from 8022 births in nulliparous women with a live, singleton, vertex-presenting fetus ≥35 weeks of gestation with a vaginal delivery. New labor curves of dilation and station were generated with 10-fold cross-validation. External validation was performed using a geographically independent group. Model variables included time from the first examination in the 20 hours before delivery; dilation, effacement, and station recorded at the previous examination; cumulative contraction counts; and use of epidural anesthesia and labor induction. To assess model accuracy, differences between each model's predicted value and its corresponding observed value were calculated. These prediction errors were summarized using mean absolute error and root mean squared error statistics. Dilation curves based on multiple parameters were more accurate than those derived from time alone. The mean absolute error of the multifactor methods was better (lower) than those of the single-factor methods (0.826 cm [95% confidence interval, 0.820–0.832] for the multifactor machine learning and 0.893 cm [95% confidence interval, 0.885–0.901] for the multifactor mixed-effects method and 2.122 cm [95% confidence interval, 2.108–2.136] for the single-factor methods; P <.0001 for both comparisons). The root mean squared errors of the multifactor methods were also better (lower) than those of the single-factor methods (1.126 cm [95% confidence interval, 1.118–1.133] for the machine learning [ P <.0001] and 1.172 cm [95% confidence interval, 1.164–1.181] for the mixed-effects methods and 2.504 cm [95% confidence interval, 2.487–2.521] for the single-factor [ P <.0001 for both comparisons]). The multifactor machine learning dilation models showed small but statistically significant improvements in accuracy compared to the mixed-effects regression models (P <.0001). The multifactor machine learning method produced a curve of descent with a mean absolute error of 0.512 cm (95% confidence interval, 0.509–0.515) and a root mean squared error of 0.660 cm (95% confidence interval, 0.655–0.666). External validation using independent data produced similar findings. Cervical dilation models based on multiple clinically relevant parameters showed improved (lower) prediction errors compared to models based on time alone. The mean prediction errors were reduced by more than 50%. A more accurate assessment of departure from expected dilation and station may help clinicians optimize intrapartum management. [ABSTRACT FROM AUTHOR]

Hydatidiform moles, including both complete and partial moles, constitute a subset of gestational trophoblastic diseases characterized by abnormal fertilization resulting in villous hydrops and trophoblastic hyperplasia with or without embryonic development. This involves chromosomal abnormalities, where one or two sperms fertilize an empty oocyte (complete hydatidiform mole (CHM); mostly 46,XX) or two sperms fertilize one oocyte (partial hydatidiform mole (PHM); mostly 69,XXY). Notably, recurrent occurrences are associated with abnormal genomic imprinting of maternal effect genes such as NLRP7 (chromosome 19q13.4) and KHDC3L (chromosome 6q1). Ongoing efforts to enhance identification methods have led to the identification of growth-specific markers, including p57 (cyclin-dependent kinase inhibitor 1C; CDKN1C), which shows intact nuclear expression in the villous cytotrophoblast and villous stromal cells in PHMs and loss of expression in CHMs. Treatment of hydatidiform moles includes dilation and curettage for uterine evacuation of the molar pregnancy followed by surveillance of human chorionic gonadotropin (HCG) levels to confirm disease resolution and rule out the development of any gestational trophoblastic neoplasia. In this review, we provide a synopsis of the existing literature on hydatidiform moles, their diagnosis, histopathologic features, and management. [ABSTRACT FROM AUTHOR]